Dr.

Mohamed El-Gindy
Professor of Surgery Mansoura com.mansfans.www

‫الحوادث المروريه فى مصر )9002(‬
‫%58 على الطرق المحليه‬ ‫%51 على الطرق السريعه‬
‫5 مليار جنيه خسائر ماديه‬ ‫52 مليون مخالفه مرورية‬ ‫62 ألف حادث‬ ‫6 ألف قتيل‬ ‫32 ألف مصاب‬

‫أخطاء بشريه‬ ‫أخطاء فنيه‬ ‫أحوال جويه‬

‫58 %‬ ‫01 %‬ ‫5 %‬

Significance of trauma
Trauma is the (neglected disease) of
modern society.

It is the number one killer under the
age of 40 years and the 4th cause of death in all ages. com.mansfans.www

Economic cost of trauma
 The economic cost of trauma to the
nation is more than $ 41 bilion annually.

 It causes permanent loss of millions of
productive work years.
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Trauma care
"

3 Rs"

The intent of any system of trauma care must be to fulfil the " 3 Rs" •To get the Right patient •To the Right hospital •At the Right time.
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The Right Hospital should fulfil also
"

3 Rs"

* It can Resuscitate the victim * It can Review (assessment, monitoring and diagnosis) * It can Repair (definitive treatment)
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It provides specialised trauma care " 3 Rs" (Resuscitate, Review & Repair) . Educate physicians and paraprofessionals in trauma care. Undertake trauma research. Treat a certain number of severly injured patient every year. com.mansfans.www

Level (I) Trauma Hospital

Trauma Categories
l) Those with injuries that are rapidly fatal (5%)

Death is inevitable
2) Stable patients (80%)

They need little expertise
3)Those with life threatining injuries and required urgent medical attention (15%).

They need more expertise

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Mechanisms of Injury
Blunt mechanisms
Forces
Compression forces Shearing forces Deceleration forces

Sources
MVCs

Seat belt injury Steering wheel injury
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Falls Assaults Blast

Mechanisms of Injury
Penetrating mechanisms
Low velocity
Knife ice pick

Medium velocity
gunshot/handgun shotgun

High velocity
high power hunting rifle military weapon

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The 3 lines of management of the injured patient are
 Immediate measures at the scene of accident.  Transportation  Emergency room care
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the victim should be
*
Handled as if severe injury has occurred.

* Protected from further trauma * Treated by trained personnel.

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5
1) Is the victim breathing ? 2) Is there a pulse or heart beats ? 3) Is there gross external bleeding ? 4) Is there any question of spine injury ? 5) Is there any obvious fractures ?

Q

?

?

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1- Asphyxia
It may be due to a. Airway obstruction. b. Acute-thoracic injury.

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a. Airway obstruction
Causes: * Blood, mucus, vomitus. * Foreign body (e.g. broken teeth) * Fallen tongue in comatosed patients.
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Management of Airway obstruction
1. Simple mandible 2. Immediate endotracheal intubation 3. Try to remove any foreign body. com.mansfans.www manipulation of the

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A B

C
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Management of Airway obstruction (CONT.)
4. One or two large-bore needles through the cricothyroid membrane. 5. A lateral and slightly head down position 6. In respiratory arrest, mouth to mouth breathing

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b. Acute Thoracic Injury
Flail Chest

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b. Acute Thoracic Injury
Open pneumothorax

b. Acute Thoracic Injury

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Tension Pneumothorax

2. Cardiac Arrest:
*Absence of heart sounds and pulse *immediate action within 4 minutes.
Mouth
to mouth breathing/5 cardiac

compressions.

* Place the victim on a hard surface. *Sharp blow with the Fist to the lower end of the sternum *4-5 cm toward the spine once/second. com.mansfans.www

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3- HEMORRHAGE *local pressure and elevation of the limb *Tourniquet *kept exposed *loosened / 20 m. for 2 m. *write ( TK ) on forehead *on uper arm or thigh *It may cause vasc. & nerve damage

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Shock
*1 ry Shock
*Hypovolemic shock

( pain and fright) ( loss of blood or plasma)

*patient must be recumbent * Analgesics should be (I V(

*fluids until blood trans.

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The lethal triad

Bleeding Acidosis hypothermia

coagulopathy

4- Fracture Spine

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Pelvic Fractures

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5-Fractures
•Splinting using boards, pillows, blankets or any other materials. •Improper handling of Fractures may cause:
a. Damage of nerves, blood vessels. b. Puncture of the skin overlying it (compound). c. Severe pain which increase the shock state. Exceptions of splinting fractures at the scene of

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II.Transportation
•Patients should be transported in the supine position. •Station wagon or truck is preferable • Resuscitation of injured patient should be

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Is Pre hospital care significantly improve the outcome

* The answer is equivocal because of : 1) Delay from receiving definitive treatment in the hospital (2) It may have adverse effects and compromise the patient further .

is a new Aproach Except for * Unavoidable delay due to entrapment. * Inaccessible sites. .* In rural locations
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The prehospital care directly affected by:
Size & demography of the population 2)( 1

Local geographical constraints

3) Rural or highly urbanized area
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Fire and police services do the BASIC support .* * Emergency paramedics do the advanced skills and communication links with the receiving hospital . * Severely injured patient may bypass the
nearest facility to the proper trauma centre

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Greater dependence on ambulance services* augmented by paramedics and physician led teams rapidly to the nearest hospital

*Transport

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Hopping for
1-The Basic Care by the

police man 2- Augment the ambulance service 3- Paramedic & physician in each 4- Advanced skills by the team inside

Hopping for
Transportation to the nearest hospital ?? Augment the communication links 7- Accident flying squads using Helicopters in inaccessible sites
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III Emergency Room Care
1- General Principles :
1) Patient clothing (cut off). 3) History of : a. medical diseases. b. circumstances of the injury . 4) Findings should be "written records“ (for medicolegal and follow up com.mansfans.www

Do not remove the stab .except in OR

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Impalement Injury

Small Intestine Injury

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III Emergency Room Care 2. Resuscitation
a.
I.V catheters

b.

I.V Fluids

c. (C. V. P.)
catheter

d. Foley’s

e. Antitetanic, antigasgangrene serum if

III Emergency Room Care 3 Laboratory Studies
* Hematocrit. * Blood count, blood sugar level. * Serum creatinine, blood urea nitrogen. * Blood grouping and proper cross matching of blood. * Serum electrolytes. * Urine analysis for sugar and hematuria if

III Emergency Room Care 4. Radiological Study
* X-ray chest and abdomen in all cases of major injury. * I.V.P. in abdominal and pelvic injuries with evidence of urinary tract injury * X-ray skull, C.T. scanning of the head in most of head injuries.

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Thermal Trauma

Extensive Thermal Trauma

Special Bed for Extensive Thermal Trauma

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Bullet Injury of the heart and abdomen
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Extensive Fissure Fracture of the Skull
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Blunt Abdominal Trauma

Flank ecchymosis from internal bleeding

Blunt Closed Abdominal Trauma

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•Certain injuries are so critical
operative treatment must be undertaken as soon as the diagnosis is made ( penetrating wound of the heart , abdominal wounds involving the aorta and vena cava )

that

•Cerebral injuries take priority in care
only when there is rapidly deepening coma and evidence of extra dural bleeding .

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Laparotomy craniotomy

for abdominal injury and for cerebral injury can be carried out simultaneously . of long bones can be treated on a semiemergency bases unless there is associated vascular injury or open fractures should be treatment as early

Fractures

Hand injury

If the patient is comatosed : The cause may be :
• Alcoholic intoxication . • Cerebro vascular accident . • Diabetic coma . • Barbiturate Poisoning • Hypovolemic shook .

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